Results Summary
What was the research about?
Senior living facilities and community centers often hold exercise classes for older adults. Exercise can help older adults improve walking ability. Improving walking ability can help older adults avoid falls and continue to live on their own. The research team wanted to see how a standard group exercise class compared with a new class called On the Move to improve walking ability.
The focus of the exercises in the On the Move class was improving walking ability. In the On the Move class, people exercised while standing up for the entire class. In the standard exercise class, people exercised while sitting down. Both classes included a warm-up, a cooldown, and gentle exercises and stretches for the whole body.
The research team also wanted to see if it mattered who taught the exercise classes. The team compared classes taught by professional exercise teachers with classes taught by trained staff at the senior centers.
What were the results?
People in the On the Move class showed greater improvement in their walking ability than those in the standard exercise class. The On the Move and standard exercise classes worked about the same in helping older adults continue living on their own.
People improved their walking ability more when exercise teachers taught the classes than when trained center staff did. When trained center staff taught the classes, the On the Move class didn’t improve people’s walking ability more than the standard exercise class did.
Who was in the study?
This study included 424 adults ages 65 or older. Some people lived in senior living facilities. Others lived in their own homes and went to senior community centers. The average age was 81. Some people had trouble walking but all could walk on their own, with or without a cane.
What did the research team do?
The study included 32 senior living facilities and community centers. The research team assigned 16 of the centers to offer the On the Move class, and the other 16 to offer the standard group exercise class. There were 201 people who took the On the Move class and 223 people who took the standard group exercise class. Each class had 10 or fewer people. Both types of classes met for 50 minutes, twice a week, for 12 weeks.
The research team checked each person’s ability to walk and move around before the study began and after taking 12 weeks of classes. The team asked people to fill out a survey and gave them two walking tests. The team used the surveys and tests to see which class helped people improve their walking ability more. The team also checked if results were the same depending on who taught the class.
What were the limits of the study?
The research team had trouble finding staff at the senior living and community centers to teach the classes. Also, fewer people finished the full 12 weeks of group exercise classes when taught by trained center staff compared with classes taught by exercise teachers. This difference could have occurred because the adults didn’t like the class, or there may have been some other reason. Lastly, the study took place in Pittsburgh, Pennsylvania. Results may be different for older adults living in other places.
Future research could look at how to help senior center staff teach group exercise classes so that those classes get the same results as ones taught by trained exercise teachers.
How can people use the results?
Senior living facilities and community centers can use these results when deciding what type of exercise classes to offer older adults to help them keep walking.
Professional Abstract
Objective
To compare the effectiveness and sustainability of the On the Move exercise program with a standard group exercise program on improving function, disability, and walking ability in older adults
Study Design
| Design Element | Description |
|---|---|
| Design |
|
| Population | 424 adults ages 65 and older attending senior community centers or living in independent-living facilities or senior apartment buildings |
| Interventions/ Comparators |
|
| Outcomes |
Self-reported function, self-reported disability, and walking ability |
| Timeframe | 12-week follow-up for study outcomes |
This randomized controlled trial compared two types of group exercise classes for older adults: a program to improve walking ability called On the Move and a standard group exercise program. The research team wanted to find out whether the On the Move program was better than the standard exercise program at improving walking ability and function and reducing disability in older adults.
The research team also wanted to know whether the On the Move program would be more sustainable if staff at senior living facilities and community centers, rather than exercise professionals, taught the classes. To that end, the study included a quasi-experimental component that compared program effectiveness by instructor type: exercise professionals versus facility staff. The exercise professionals included physical therapists and exercise physiologists. The facility staff who taught classes had varied backgrounds in teaching exercise.
Researchers randomized facilities based on the type of exercise program. If the researchers identified staff at a facility to teach the exercise program, the researchers then randomized participants at that facility by instructor type. Of the 32 facilities in the study, 16 used the On the Move program (201 participants: 152 taught by exercise professionals, 49 taught by facility staff), and 16 used the standard group exercise program (223 participants: 146 taught by exercise professionals, 77 taught by facility staff).
Participants in both types of exercise class met twice a week for 12 weeks. Each class had 10 or fewer participants. The exercises in the On the Move class took place in a standing position and focused on timing and coordination, which are important for walking. The standard group exercise program focused on strength, endurance, and flexibility; this class took place in a seated position for the entire class.
The study included 424 adults ages 65 and older who were able to walk independently. The mean patient age was 81 years. Some participants lived in independent-living facilities or senior apartment buildings; others lived in their own homes and attended senior community centers.
Primary outcomes were self-reported physical function and disability, measured by the Late-Life Function and Disability Instrument (LLFDI) function and disability frequency domains, and walking ability, measured by the six-minute walk test and gait speed. The research team collected data at baseline and immediately after participants completed their assigned 12-week intervention.
Results
Effectiveness: Participants in the On the Move program had greater improvement in the six-minute walk test than participants in the standard group exercise program did (p = 0.023). There were no significant differences between groups in gait speed or self-reported function and disability.
When exercise professionals taught both exercise programs, the On the Move participants had greater improvements in both measures of walking ability than participants in the standard group exercise program did (six-minute walk test, p = 0.026; gait speed, p = 0.0008).
Sustainability: Compared with participants in the On the Move classes taught by facility staff, participants in the On the Move classes taught by exercise professionals tended to have greater improvements in LLFDI overall function (p = 0.06) and gait speed (p = 0.06). The On the Move classes taught by facility staff did not elicit greater gains in study outcomes than standard group exercise classes taught by facility staff.
Limitations
This study took place in Pittsburgh, Pennsylvania; results may be different in other locations. The research team had difficulty identifying staff at senior living facilities to lead either group exercise class. The team was therefore unable to randomize participants by instructor type at all facilities and could not conduct adequately powered analyses as originally planned. A study with greater power might have been able to detect meaningful differences between the programs that this study could not. Attrition was greater in classes taught by facility staff; it is not clear whether this attrition was related to the instructors or to other factors. Facility staff trained to teach the On the Move class had varied training and exercise experience; however, researchers did not attempt to measure or quantify these differences.
Conclusions and Relevance
Compared with the standard group exercise program, the On the Move group exercise program elicited greater improvements in walking ability as measured by the six-minute walk test, when taught by exercise professionals. These findings suggest that the exercises included in the On the Move program may be beneficial for older adults. However, the findings also suggest that the program is more advantageous when taught by exercise professionals.
Future Research Needs
Future research could focus on finding ways to improve the effectiveness of classes taught by senior-center and assisted-living staff so that the classes they teach are as effective as those taught by exercise professionals.
Final Research Report
View this project's final research report.
Journal Citations
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
The awardee made the following revisions in response to peer review:
- The awardee revised the explanation of randomization by emphasizing that it was impossible to randomly assign participants to exercise leaders because some facilities had too few leaders. Consequently, the resulting comparisons of outcomes for patients receiving the intervention from exercise leaders or facility staff should be considered exploratory and interpreted with caution.
- The awardee explained their choice of the standard intervention as the comparator to On the Move. The standard intervention did not have a walking or weight-bearing component, but the awardee stated this was typical for interventions usually offered at study sites.
- The awardee emphasized the exploratory nature of the heterogeneity of treatment effects (HTE) analyses, because they were not prespecified. The awardee indicated that readers should consider the findings tentative.
- The awardee provided more information about strengths and limitations of the study sample. The awardee addressed reviewers’ concerns about the homogeneity of the study population by commenting that although the sample had limited racial and ethnic diversity, participants’ living arrangements were diverse. The investigators also noted the exclusion from the study of patients with significant movement and sensory disabilities, or who needed assistive devices.